1
|
Juárez SP, Debiasi E, Wallace M, Drefahl S, Mussino E, Cederström A, Rostila M, Aradhya S. COVID-19 mortality among immigrants by duration of residence in Sweden: a population-based cohort study. Scand J Public Health 2024; 52:370-378. [PMID: 38600446 PMCID: PMC11067384 DOI: 10.1177/14034948241244560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/18/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Explanations for the disproportional COVID-19 burden among immigrants relative to host-country natives include differential exposure to the virus and susceptibility due to poor health conditions. Prior to the pandemic, immigrants displayed deteriorating health with duration of residence that may be associated with increased susceptibility over time. The aim of this study was to compare immigrant-native COVID-19 mortality by immigrants' duration of residence to examine the role of differential susceptibility. METHODS A population-based cohort study was conducted with individuals between 18 and 100 years old registered in Sweden between 1 January 2015 and 15 June 2022. Cox regression models were run to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Inequalities in COVID-19 mortality between immigrants and the Swedish-born population in the working-age group were concentrated among those of non-Western origins and from Finland with more than 15 years in Sweden, while for those of retirement age, these groups showed higher COVID-19 mortality HRs regardless of duration of residence. Both age groups of immigrants from Africa and the Middle East showed consistently higher COVID-19 mortality HRs. For the working-age population: Africa: HR<15: 2.46, 95%CI: 1.78, 3.38; HR≥15: 1.49, 95%CI: 1.01, 2.19; and from the Middle East: HR<15: 1.20, 95%CI: 0.90, 1.60; HR≥15: 1.65, 95%CI: 1.32, 2.05. For the retirement-age population: Africa: HR<15: 3.94, 95%CI: 2.85, 5.44; HR≥15: 1.66, 95%CI: 1.32, 2.09; Middle East: HR<15: 3.27, 95%CI: 2.70, 3.97; HR≥15: 2.12, 95%CI: 1.91, 2.34. CONCLUSIONS Differential exposure, as opposed to differential susceptibility, likely accounted for the higher COVID-19 mortality observed among those origins who were disproportionately affected by the pandemic in Sweden.
Collapse
Affiliation(s)
- Sol P. Juárez
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Enrico Debiasi
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Matthew Wallace
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Sweden
| | - Sven Drefahl
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Sweden
| | - Eleonora Mussino
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Sweden
| | - Agneta Cederström
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden
| | - Siddartha Aradhya
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Sweden
| |
Collapse
|
2
|
Kolk M, Andersson L, Pettersson E, Drefahl S. The Swedish Kinship Universe: A Demographic Account of the Number of Children, Parents, Siblings, Grandchildren, Grandparents, Aunts/Uncles, Nieces/Nephews, and Cousins Using National Population Registers. Demography 2023; 60:1359-1385. [PMID: 37680176 DOI: 10.1215/00703370-10955240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Given that surprisingly little is known about the demography of human kinship, we provide a demographic account of the kinship networks of individuals in Sweden in 2017 across sex and cohort between ages 0 and 102. We used administrative register data of the full population of Sweden to provide the first kinship enumeration for a complete population based on empirical data. We created ego-focused kinship networks of children, parents, siblings, grandchildren, grandparents, aunts and uncles, nieces and nephews, and cousins. We show the average number of kin of different types, the distribution of the number of kin, and changes in dispersion over time. A large share of all kin of an individual are horizontal kin, such as cousins. We observe the highest number of kin-on average, roughly 20-around age 35. We show differences between matrilineal and patrilineal kin and differences in the kinship structure arising from fertility with more than one childbearing partner, such as half-siblings. The results demonstrate substantial variability in kinship within a population. We discuss our findings in the context of other methods to estimate kinship.
Collapse
Affiliation(s)
- Martin Kolk
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
- Institute for Future Studies, Stockholm, Sweden; Åbo Akademi, Vaasa, Finland
| | - Linus Andersson
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
- Department of Sociology, Turku University, Turku, Finland
| | - Emma Pettersson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Sven Drefahl
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| |
Collapse
|
3
|
Oksuzyan A, Drefahl S, Caputo J, Aradhya S. Is it Better to Intermarry? Immigration Background of Married Couples and Suicide Risk Among Native-Born and Migrant Persons in Sweden. Eur J Popul 2023; 39:8. [PMID: 36890348 PMCID: PMC9995640 DOI: 10.1007/s10680-023-09650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/13/2022] [Indexed: 03/10/2023]
Abstract
Marriage is protective against suicide across most populations, including for persons of different ethnicities and immigrant backgrounds. However, the well-being benefits of marriage are contingent upon marital characteristics-such as conflict and quality-that may vary across spousal dyads with different immigration backgrounds. Leveraging Swedish register data, we compare suicide mortality among married persons on the basis of their and their spouse's immigration backgrounds. We find that relative to those in a native Swede-Swede union, Swedish men married to female immigrants and immigrant women married to native men are at higher risk of death by suicide, while immigrants of both genders who are married to someone from their birth country have a lower risk of suicide mortality. The findings support hypotheses about the strains that may be encountered by those who intermarry, as well as the potential selection of individuals into inter- and intra-ethnic marriages.
Collapse
Affiliation(s)
- Anna Oksuzyan
- Chair of Demography and Health, School of Public Health, Bielefeld University, 33615, Bielefeld, Germany.
- Max Planck Institute for Demographic Research, Rostock, Germany.
| | - Sven Drefahl
- Demography Unit, Institute of Sociology, Stockholm University, Stockholm, Sweden
| | - Jennifer Caputo
- Center for Health and the Social Sciences and Department of Sociology, University of Chicago, Chicago, USA
- Westat, Rockville, MD, USA
| | - Siddartha Aradhya
- Demography Unit, Institute of Sociology, Stockholm University, Stockholm, Sweden
| |
Collapse
|
4
|
Meyer AC, Ebeling M, Drefahl S, Hedström M, Ek S, Sandström G, Modig K. The Impact of Hip Fracture on Geriatric Care and Mortality Among Older Swedes: Mapping Care Trajectories and Their Determinants. Am J Epidemiol 2022; 192:41-50. [PMID: 35968686 PMCID: PMC9825727 DOI: 10.1093/aje/kwac149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 06/16/2022] [Accepted: 08/10/2022] [Indexed: 01/12/2023] Open
Abstract
In this study, we examined the impact of hip fractures on trajectories of home care, nursing home residence, and mortality among individuals aged 65 years or more and explored the impacts of living arrangements, cohabitation, frailty, and socioeconomic position on these trajectories. Based on a linkage of nationwide Swedish population registers, our study included 20,573 individuals with first hip fracture in 2014-2015. Care trajectories during the 2 years following the fracture were visualized and compared with those of 2 hip-fracture-free control groups drawn from the general population: age- and sex-matched controls and health-matched controls identified through propensity score matching. Multistate modeling was employed to identify sociodemographic and health-related factors associated with care trajectories among hip fracture patients. We found that hip fracture patients already had worse health than the general population before their fracture. However, when controlling for prefracture health, hip fractures still had a considerable impact on use of elder-care services and mortality. Comparisons with the health-matched controls suggest that hip fractures have an immediate, yet short-term, impact on care trajectories. Long-term care needs are largely attributable to poorer health profiles independent of the fracture itself. This emphasizes the importance of adequate comparison groups when examining the consequences of diseases which are often accompanied by other underlying health problems.
Collapse
Affiliation(s)
- Anna C Meyer
- Correspondence to Dr. Anna C. Meyer, Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, P.O. Box 210, SE-171 77 Stockholm, Sweden (e-mail: )
| | | | | | | | | | | | | |
Collapse
|
5
|
Wallace M, Thomas MJ, Aburto JM, Jørring Pallesen AV, Mortensen LH, Syse A, Drefahl S. Immigration, mortality, and national life expectancy in the Nordic region, 1990–2019. SSM Popul Health 2022; 19:101177. [PMID: 36046066 PMCID: PMC9421394 DOI: 10.1016/j.ssmph.2022.101177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Immigrants have higher life expectancy at age 1 than the native-born in Denmark, Finland and Norway do from 1990 to 2019. Immigrants in Denmark, Finland and Norway increasingly enhance national life expectancy at age 1 over time. Immigrants in Sweden have lower life expectancy at age 1 than native-born in Sweden do in 1990, but similar levels by 2019. The effect of immigrants on national life expectancy at age 1 in Sweden transforms from negative to positive over time. The unique mortality of immigrants affects rankings of life expectancy at age 1 in the Nordic region in recent years.
Collapse
Affiliation(s)
- Matthew Wallace
- Stockholm University, Stockholm, Sweden
- Corresponding author. Sociology Department, Stockholm University, SE-106 91, Stockholm, Sweden.
| | | | - José Manuel Aburto
- University of Oxford, Oxford, England, UK
- University of Southern Denmark, Odense, Denmark
| | | | - Laust Hvas Mortensen
- University of Copenhagen, Copehagen, Denmark
- Statistics Denmark, Copehagen, Denmark
| | - Astri Syse
- Norwegian Institute of Public Health, Oslo, Norway
| | | |
Collapse
|
6
|
Caputo J, Carollo A, Mussino E, Ahrenfeldt LJ, Lindahl-Jacobsen R, Drefahl S, Oksuzyan A. Spousal order of migration, gender, and hospitalization among immigrants in Denmark. Scand J Public Health 2022; 50:172-179. [PMID: 32862798 DOI: 10.1177/1403494820944724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Certain migration contexts that may help clarify immigrants' health needs are understudied, including the order in which married individuals migrate. Research shows that men, who are healthier than women across most populations, often migrate to a host country before women. Using Danish register data, we investigate descriptive patterns in the order that married men and women arrive in Denmark, as well as whether migration order is related to overnight hospitalizations. Methods: The study base includes married immigrants who lived in Denmark between January 1, 1980 and December 31, 2014 (N = 13,680). We use event history models to examine the influence of spousal migration order on hospitalizations. Results: The order that married individuals arrive in Denmark is indeed highly gendered, with men tending to arrive first, and varies by country of origin. Risk of hospitalization after age 50 does not depend on whether an individual migrated before, after, or at the same time as their spouse among either men or women. However, among those aged 18+, men migrating before their wives are more likely to experience hospitalizations within the first 5 years of arrival. Conclusions: These findings provide the first key insights about gendered migration patterns in Denmark. Although spousal order of migration is not related to overnight hospitalization among women, our findings provide preliminary evidence that men age 18+ who are first to arrive experience more hospitalization events in the following 5 years. Future research should explore additional outcomes and whether other gendered migration contexts are related to immigrants' health.
Collapse
Affiliation(s)
- Jennifer Caputo
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Angela Carollo
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Eleonora Mussino
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sven Drefahl
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Anna Oksuzyan
- Max Planck Institute for Demographic Research, Rostock, Germany
| |
Collapse
|
7
|
Billingsley S, Brandén M, Aradhya S, Drefahl S, Andersson G, Mussino E. COVID-19 mortality across occupations and secondary risks for elderly individuals in the household: A population register-based study. Scand J Work Environ Health 2022; 48:52-60. [PMID: 34665872 PMCID: PMC8729161 DOI: 10.5271/sjweh.3992] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This is the first population-level study to examine inequalities in COVID-19 mortality according to working-age individuals' occupations and the indirect occupational effects on COVID-19 mortality of older individuals who live with them. METHODS We used early-release data for the entire population of Sweden of all recorded COVID-19 deaths from 12 March 2020 to 23 February 2021, which we linked to administrative registers and occupational measures. Cox proportional hazard models assessed relative risks of COVID-19 mortality for the working-aged population registered in an occupation in December 2018 and the older population who lived with them. RESULTS Among working aged-adults, taxi/bus drivers had the highest relative risk of COVID-19 mortality: over four times that of skilled workers in IT, economics, or administration when adjusted only for basic demographic characteristics. After adjusting for socioeconomic factors (education, income and country of birth), there are no occupational groups with clearly elevated (statistically significant) COVID-19 mortality. Neither a measure of exposure within occupations nor the share that generally can work from home were related to working-aged adults' risk of COVID-19 mortality. Instead of occupational factors, traditional socioeconomic risk factors best explained variation in COVID-19 mortality. Elderly individuals, however, faced higher COVID-19 mortality risk both when living with a delivery or postal worker or worker(s) in occupations that generally work from home less, even when their socioeconomic factors are taken into account. CONCLUSIONS Inequalities in COVID-19 mortality of working-aged adults were mostly based on traditional risk factors and not on occupational divisions or characteristics in Sweden. However, older individuals living with those who likely cannot work from home or work in delivery or postal services were a vulnerable group.
Collapse
Affiliation(s)
- Sunnee Billingsley
- Stockholm University, Department of Sociology, Demography Unit, 106 91 Stockholm, Sweden.
| | | | | | | | | | | |
Collapse
|
8
|
Aradhya S, Brandén M, Drefahl S, Obućina O, Andersson G, Rostila M, Mussino E, Juárez SP. Intermarriage and COVID-19 mortality among immigrants. A population-based cohort study from Sweden. BMJ Open 2021; 11:e048952. [PMID: 34465581 PMCID: PMC8413476 DOI: 10.1136/bmjopen-2021-048952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/28/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate the role of language proficiency and institutional awareness in explaining excess COVID-19 mortality among immigrants. DESIGN Cohort study with follow-up between 12 March 2020 and 23 February 2021. SETTING Swedish register-based study on all residents in Sweden. PARTICIPANTS 3 963 356 Swedish residents in co-residential unions who were 30 years of age or older and alive on 12 March 2020 and living in Sweden in December 2019. OUTCOME MEASURES Cox regression models were conducted to assess the association between different constellations of immigrant-native couples (proxy for language proficiency and institutional awareness) and COVID-19 mortality and all other causes of deaths (2019 and 2020). Models were adjusted for relevant confounders. RESULTS Compared with Swedish-Swedish couples (1.18 deaths per thousand person-years), both immigrants partnered with another immigrant and a native showed excess mortality for COVID-19 (HR 1.43; 95% CI 1.29 to 1.58 and HR 1.24; 95% CI 1.10 to 1.40, respectively), which translates to 1.37 and 1.28 deaths per thousand person-years. Moreover, similar results are found for natives partnered with an immigrant (HR 1.15; 95% CI 1.02 to 1.29), which translates to 1.29 deaths per thousand person-years. Further analysis shows that immigrants from both high-income and low-income and middle-income countries (LMIC) experience excess mortality also when partnered with a Swede. However, having a Swedish-born partner is only partially protective against COVID-19 mortality among immigrants from LMIC origins. CONCLUSIONS Language barriers and/or poor institutional awareness are not major drivers for the excess mortality from COVID-19 among immigrants. Rather, our study provides suggestive evidence that excess mortality among immigrants is explained by differential exposure to the virus.
Collapse
Affiliation(s)
- Siddartha Aradhya
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Maria Brandén
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Stockholm, Sweden
- The Institute for Analytical Sociology (IAS), Linköping University, Linkoping, Sweden
| | - Sven Drefahl
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Ognjen Obućina
- Institut national d'études démographiques (INED), Aubervilliers, France
| | - Gunnar Andersson
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Eleonora Mussino
- Stockholm University Demography Unit (SUDA), Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Sol Pía Juárez
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| |
Collapse
|
9
|
Meyer AC, Ek S, Drefahl S, Ahlbom A, Hedström M, Modig K. Trends in Hip Fracture Incidence, Recurrence, and Survival by Education and Comorbidity: A Swedish Register-based Study. Epidemiology 2021; 32:425-433. [PMID: 33512961 PMCID: PMC8011509 DOI: 10.1097/ede.0000000000001321] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/13/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hip fractures are common and severe conditions among older individuals, associated with high mortality, and the Nordic countries have the highest incidence rates globally. With this study, we aim to present a comprehensive picture of trends in hip fracture incidence and survival in the older Swedish population stratified by education, birth country, and comorbidity level. METHODS This study is based on a linkage of several population registers and included the entire population over the age of 60 living in Sweden. We calculated age-standardized incidence rates for first and recurrent hip fractures as well as age-standardized proportions of patients surviving 30 and 365 days through the time period 1998 to 2017. We calculated all outcomes for men and women in the total population and in each population stratum. RESULTS Altogether, we observed 289,603 first hip fractures during the study period. Age-standardized incidence rates of first and recurrent fractures declined among men and women in the total population and in each educational-, birth country-, and comorbidity group. Declines in incidence were more pronounced for recurrent than for first fractures. Approximately 20% of women and 30% of men died within 1 year of their first hip fracture. Overall, survival proportions remained constant throughout the study period but improved when taking into account comorbidity level. CONCLUSIONS Hip fracture incidence has declined across the Swedish population, but mortality after hip fracture remained high, especially among men. Hip fracture patients constitute a vulnerable population group with increasing comorbidity burden and high mortality risk.
Collapse
Affiliation(s)
- Anna C. Meyer
- From the Institute of Environmental Medicine, Karolinska Institutet, Unit of Epidemiology, Stockholm, Sweden
| | - Stina Ek
- From the Institute of Environmental Medicine, Karolinska Institutet, Unit of Epidemiology, Stockholm, Sweden
| | - Sven Drefahl
- Demography Unit, Stockholm University, Stockholm, Sweden
| | - Anders Ahlbom
- From the Institute of Environmental Medicine, Karolinska Institutet, Unit of Epidemiology, Stockholm, Sweden
| | - Margareta Hedström
- Department of Clinical Sciences, Intervention and Technology (CLINTEC) Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Modig
- From the Institute of Environmental Medicine, Karolinska Institutet, Unit of Epidemiology, Stockholm, Sweden
| |
Collapse
|
10
|
Brandén M, Aradhya S, Kolk M, Härkönen J, Drefahl S, Malmberg B, Rostila M, Cederström A, Andersson G, Mussino E. Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data. Lancet Healthy Longev 2020; 1:e80-e88. [PMID: 33521770 PMCID: PMC7832817 DOI: 10.1016/s2666-7568(20)30016-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Housing characteristics and neighbourhood context are considered risk factors for COVID-19 mortality among older adults. The aim of this study was to investigate how individual-level housing and neighbourhood characteristics are associated with COVID-19 mortality in older adults. METHODS For this population-based, observational study, we used data from the cause-of-death register held by the Swedish National Board of Health and Welfare to identify recorded COVID-19 mortality and mortality from other causes among individuals (aged ≥70 years) in Stockholm county, Sweden, between March 12 and May 8, 2020. This information was linked to population-register data from December, 2019, including socioeconomic, demographic, and residential characteristics. We ran Cox proportional hazards regressions for the risk of dying from COVID-19 and from all other causes. The independent variables were area (m2) per individual in the household, the age structure of the household, type of housing, confirmed cases of COVID-19 in the borough, and neighbourhood population density. All models were adjusted for individual age, sex, country of birth, income, and education. FINDINGS Of 279 961 individuals identified to be aged 70 years or older on March 12, 2020, and residing in Stockholm in December, 2019, 274 712 met the eligibility criteria and were included in the study population. Between March 12 and May 8, 2020, 3386 deaths occurred, of which 1301 were reported as COVID-19 deaths. In fully adjusted models, household and neighbourhood characteristics were independently associated with COVID-19 mortality among older adults. Compared with living in a household with individuals aged 66 years or older, living with someone of working age (<66 years) was associated with increased COVID-19 mortality (hazard ratio 1·6; 95% CI 1·3-2·0). Living in a care home was associated with an increased risk of COVID-19 mortality (4·1; 3·5-4·9) compared with living in independent housing. Living in neighbourhoods with the highest population density (≥5000 individuals per km2) was associated with higher COVID-19 mortality (1·7; 1·1-2·4) compared with living in the least densely populated neighbourhoods (0 to <150 individuals per km2). INTERPRETATION Close exposure to working-age household members and neighbours is associated with increased COVID-19 mortality among older adults. Similarly, living in a care home is associated with increased mortality, potentially through exposure to visitors and care workers, but also due to poor underlying health among care-home residents. These factors should be considered when developing strategies to protect this group. FUNDING Swedish Research Council for Health, Working Life and Welfare (FORTE), Swedish Foundation for Humanities and Social Sciences.
Collapse
Affiliation(s)
- Maria Brandén
- The Institute for Analytical Sociology, Linköping University, Norrköping, Sweden
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Siddartha Aradhya
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Martin Kolk
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
- Institute for Futures Studies, Stockholm, Sweden
| | - Juho Härkönen
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
- Department of Political and Social Sciences, European University Institute, San Domenico di Fiesole, Italy
| | - Sven Drefahl
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Bo Malmberg
- Department of Human Geography, Stockholm University, Stockholm, Sweden
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden
| | - Agneta Cederström
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Andersson
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Eleonora Mussino
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| |
Collapse
|
11
|
Abstract
BACKGROUND During the past decades, life expectancy has continued to increase in most high-income countries. Previous research suggests that improvements in life expectancy have primarily been driven by advances at the upper end of the health distribution, while parts of the population have lagged behind. Using data from the entire Swedish population, this study aims to examine the life expectancy development among subgroups of individuals with a history of common diseases relative to that of the general population. METHODS The remaining life expectancy at age 65 was estimated for each year in 1998-2017 among individuals with a history of disease, and for the total Swedish population. We defined population subgroups as individuals with a history of myocardial infarction, ischemic or hemorrhagic stroke, hip fracture, or colon, breast, or lung cancer. We further distinguished between different educational levels and Charlson comorbidity index scores. RESULTS Life expectancy gains have been larger for men and women with a history of myocardial infarction, ischemic or hemorrhagic stroke, and colon or breast cancer than for the general population. The life expectancy gap between individuals with a history of hip fracture or lung cancer and the general population has, however, been growing. Education and comorbidity have affected mortality levels, but have not altered the rate of increase in life expectancy among individuals with disease history. The female advantage in life expectancy was less pronounced among individuals with disease history than among the general population. CONCLUSIONS Life expectancy has increased faster in many subpopulations with a history of disease than in the general population, while still remaining at lower levels. Improvements in life expectancy have been observed regardless of comorbidity or educational level. These findings suggest that the rise in overall life expectancy reflects more than just improved survival among the healthy or the delayed onset of disease.
Collapse
Affiliation(s)
- Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden.
| | - Sven Drefahl
- Demography Unit, Stockholm University, SE-10691, Stockholm, Sweden
| | - Anders Ahlbom
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, SE-17177, Stockholm, Sweden.,Regional Cancer Centre, University Hospital, SE-751 85, Uppsala, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77, Stockholm, Sweden
| |
Collapse
|
12
|
Abstract
Estimating the number of individuals living in a country is an essential task for demographers. This study assesses the potential bias in estimating the size of different migrant populations due to over-coverage in population registers. Over-coverage-individuals registered but not living in a country-is an increasingly pressing phenomenon; however, there is no common understanding of how to deal with over-coverage in demographic research. This study examines different approaches to and improvements in over-coverage estimation using Swedish total population register data. We assess over-coverage levels across migrant groups, test how estimates of age-specific death and fertility rates are affected when adjusting for over-coverage, and examine whether over-coverage can explain part of the healthy migrant paradox. Our results confirm the existence of over-coverage and we find substantial changes in mortality and fertility rates, when adjusted, for people of migrating age. Accounting for over-coverage is particularly important for correctly estimating migrant fertility.
Collapse
|
13
|
Erlangsen A, Drefahl S, Haas A, Bjorkenstam C, Nordentoft M, Andersson G. Suicide among persons who entered same-sex and opposite-sex marriage in Denmark and Sweden, 1989-2016: a binational, register-based cohort study. J Epidemiol Community Health 2019; 74:78-83. [PMID: 31722984 PMCID: PMC6929702 DOI: 10.1136/jech-2019-213009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/27/2019] [Accepted: 10/13/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND People belonging to sexual minority groups have higher levels of suicidality than heterosexuals. However, findings regarding suicide death are sparse. Using unique national data from two countries, we investigated whether individuals entering a same-sex marriage (SSM), a proxy group of sexual minority individuals, had higher suicide rates than those entering opposite-sex marriage (OSM). METHODS A cohort study of all males and females who entered an SSM (n=28 649) or OSM (n=3 918 617) in Denmark and Sweden during 1989-2016 was conducted. Incidence rate ratios (IRRs) for suicide were calculated using adjusted Poisson regression models. RESULTS In total, 97 suicides occurred among individuals who had entered an SSM compared with 6074 among those who entered an OSM, corresponding to an adjusted IRR of 2.3 (95% CI 1.9 to 2.8). For people who entered SSM, a 46% decline was noted over time from an IRR of 2.8 (95% CI 1.9 to 4.0) during 1989-2002 to 1.5 (95% CI 1.2 to 1.9) during 2003-2016. The excess suicide mortality was present in all age groups but most pronounced among younger individuals aged 18-34 years of age (IRR 2.7, 95% CI 1.5 to 4.8) and females (IRR 2.7, 95% CI 1.8 to 3.9). CONCLUSION This large register-based study found higher suicide rates among individuals who entered an SSM, compared with those who entered an OSM. A lower suicide rate was noted for individuals in SSMs in recent years. More research is needed to identify the unique suicide risk and protective factors for sexual minority people.
Collapse
Affiliation(s)
- Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark .,Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sven Drefahl
- Stockholm University Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Ann Haas
- Department of Health Sciences, Lehman College, City University of New York, New York City, New York, USA
| | - Charlotte Bjorkenstam
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Andersson
- Stockholm University Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| |
Collapse
|
14
|
Oksuzyan A, Mussino E, Drefahl S. Sex differences in mortality in migrants and the Swedish-born population: Is there a double survival advantage for immigrant women? Int J Public Health 2019; 64:377-386. [PMID: 30799526 PMCID: PMC6451703 DOI: 10.1007/s00038-019-01208-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/10/2018] [Accepted: 01/18/2019] [Indexed: 01/03/2023] Open
Abstract
Objectives In the present study, we examine whether the relationships between country of origin or reason for migration and mortality differ between men and women. Methods We apply hazard regression models on high-quality Swedish register data with nationwide coverage. Results Relative to their Swedish counterparts, migrants from Nordic and East European (EU) countries and former Yugoslavia have higher mortality. This excess mortality among migrants relative to Swedes is more pronounced in men than in women. Migrants from Western and Southern European countries; Iran, Iraq, and Turkey; Central and South America; and Asia, have lower mortality than Swedes, and the size of the mortality reduction is similar in both sexes. The predictive effects of the reason for migration for mortality are also similar in migrant men and women. Conclusions This study provides little support for the hypothesis of a double survival advantage among immigrant women in Sweden. However, it does show that the excess mortality in migrants from Nordic and EU countries and former Yugoslavia relative to the Swedish-born population is more pronounced in men than in women. Electronic supplementary material The online version of this article (10.1007/s00038-019-01208-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anna Oksuzyan
- Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, 18057, Rostock, Germany.
| | - Eleonora Mussino
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Sven Drefahl
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| |
Collapse
|
15
|
Billingsley S, Drefahl S, Ghilagaber G. An application of diagonal reference models and time-varying covariates in social mobility research on mortality and fertility. Soc Sci Res 2018; 75:73-82. [PMID: 30080493 DOI: 10.1016/j.ssresearch.2018.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/29/2018] [Accepted: 06/20/2018] [Indexed: 05/14/2023]
Abstract
In social mobility research, the diagonal reference model (DRM) is argued to best isolate the effect of social mobility from origin and destination status effects. In demographic research, standard analyses of the duration until an event occurs rely heavily on the appropriate use of covariates that change over time. We apply these best-practice methods to the study of social mobility and demographic outcomes in Sweden using register data that covers the years 1996-2012. The mortality analysis includes 1,024,142 women and 747,532 men and the fertility analysis includes 191,142 women and 164,368 men. We identify the challenges inherent in this combination and present strategies with an application to how social mobility is related to both fertility and mortality. Our application is successful at incorporating all requirements related to these methods. Our findings suggest, however, that certain data characteristics, such as a relatively high share of missing data, can be problematic. We also find that controlling for origin and destination status generally provides acceptable estimates of the mobility association in the specific case of Sweden and the relationship between social mobility and both fertility and mortality.
Collapse
Affiliation(s)
| | - Sven Drefahl
- Demography Unit, Department of Sociology, Stockholm University, Sweden
| | | |
Collapse
|
16
|
Modig K, Drefahl S, Ahlbom A. [Not Available]. Lakartidningen 2018; 115:E7Y3. [PMID: 30106457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Karin Modig
- Karolinska Institutet - Institute of Environmental Medicine Stockholm, Sweden Karolinska Institutet - Institute of Environmental Medicine Stockholm, Sweden
| | - Sven Drefahl
- Stockholm University - Sociology Stockholm, Sweden Stockholm University - Sociology Stockholm, Sweden
| | - Anders Ahlbom
- Karolinska Institutet - institute of Environmental Medicine Stockholm, Sweden -
| |
Collapse
|
17
|
Juárez SP, Drefahl S, Dunlavy A, Rostila M. All-cause mortality, age at arrival, and duration of residence among adult migrants in Sweden: A population-based longitudinal study. SSM Popul Health 2018; 6:16-25. [PMID: 30109257 PMCID: PMC6089090 DOI: 10.1016/j.ssmph.2018.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 12/05/2022] Open
Abstract
Background A mortality advantage has been observed among recently arrived immigrants in multiple national contexts, even though many immigrants experience more social disadvantage compared to natives. This is the first study to investigate the combined influence of duration of residence and age at arrival on the association between region of origin and all-cause mortality among the adult immigrant population in Sweden. Methods Using population-based registers, we conducted a follow-up study of 1,363,429 individuals aged 25–64 years from 1990 to 2008. Gompertz parametric survival models were fitted to derive hazard ratios (HR) for all-cause mortality. Results Compared to native Swedes, we observed a health advantage in all group of immigrants, with the exception of individuals from Finland. However, when information on age at arrival and duration of residence was combined, an excess mortality risk was found among immigrants who arrived before age 18, which largely disappeared after 15 years of residence in Sweden. Non-European immigrants over age 18 showed similar or lower mortality risks than natives in all categories of age at arrival, regardless of duration of residence. Conclusions The findings suggest that the mortality advantage commonly observed among immigrants is not universal. Combined information on age at arrival and duration of residence can be used to identify sensitive periods and to identify possible selection bias. The study also suggests that young immigrants are a vulnerable subpopulation. Given the increased number of unaccompanied minors arriving in Europe, targeted health or integration policies should be developed or reviewed. Age at arrival and duration of residence modify immigrant’s risk of mortality. There is an excess mortality risk among immigrants who arrived in Sweden as minors. This excess risk was less evident in immigrants with 15 years or more of residence in Sweden. Age at arrival and duration of residence can be used to identify sensitive periods.
Collapse
Affiliation(s)
- Sol P Juárez
- Department of Public Health Sciences, Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, Stockholm, Sweden.,Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
| | - Sven Drefahl
- Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
| | - Andrea Dunlavy
- Department of Public Health Sciences, Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, Stockholm, Sweden
| | - Mikael Rostila
- Department of Public Health Sciences, Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
18
|
Lagergren J, Andersson G, Talbäck M, Drefahl S, Bihagen E, Härkönen J, Feychting M, Ljung R. Marital status, education, and income in relation to the risk of esophageal and gastric cancer by histological type and site. Cancer 2015; 122:207-12. [PMID: 26447737 DOI: 10.1002/cncr.29731] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 09/14/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Marital status, income, and education might influence the risk of esophageal and gastric cancer, but the literature is limited. A large study addressing subtypes of these tumors was used to clarify these associations. METHODS A nationwide, Swedish population-based cohort study from 1991 to 2010 included individuals who were 50 years old or older. Data on exposures, covariates, and outcomes were obtained from well-maintained registers. Four esophagogastric tumor subtypes were analyzed in combination and separately: esophageal adenocarcinoma, esophageal squamous cell carcinoma, cardia adenocarcinoma, and noncardia gastric adenocarcinoma. Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and adjusted for confounders. RESULTS Among 4,734,227 participants (60,634,007 person-years), 24,095 developed esophageal or gastric cancer. In comparison with individuals in a long marriage, increased IRRs were found among participants who were in a shorter marriage or were never married, remarried, divorced, or widowed. These associations were indicated for each tumor subtype but were generally stronger for esophageal squamous cell carcinoma. Higher education and income were associated with decreased IRRs in a seemingly dose-response manner and similarly for each subtype. In comparison with the completion of only primary school, higher tertiary education rendered an IRR of 0.64 (95% CI, 0.60-0.69) for men and an IRR of 0.68 (95% CI, 0.61-0.75) for women. Comparing participants in the highest and lowest income brackets (highest 20% vs lowest 20%) revealed an IRR of 0.74 (95% CI, 0.70-0.79) for men and an IRR of 0.83 (95% CI, 0.76-0.91) for women. CONCLUSIONS Divorce, widowhood, living alone, low educational attainment, and low income increase the risk of each subtype of esophageal and gastric cancer. These associations require attention when high-risk individuals are being identified. Cancer 2016;122:207-212. © 2015 American Cancer Society.
Collapse
Affiliation(s)
- Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, United Kingdom
| | - Gunnar Andersson
- Stockholm University Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Drefahl
- Stockholm University Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Erik Bihagen
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Juho Härkönen
- Stockholm University Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Ljung
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| |
Collapse
|
19
|
Karampampa K, Ahlbom A, Michaëlsson K, Andersson T, Drefahl S, Modig K. Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival--A nationwide study of the Swedish population 60 years and older. Bone 2015; 78:55-61. [PMID: 25933944 DOI: 10.1016/j.bone.2015.04.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hip fracture is a common cause of disability and mortality among the elderly. Declining incidence trends have been observed in Sweden. Still, this condition remains a significant public health problem since Sweden has one of the highest incidences worldwide. Yet, no Swedish lifetime risk or survival trends have been presented. By examining how hip fracture incidence, post-fracture survival, as well as lifetime risk have developed between 1995 and 2010 in Sweden, this study aims to establish how the burden hip fractures pose on the elderly changed over time, in order to inform initiatives for improvements of their health. MATERIAL AND METHODS The entire Swedish population 60 years-old and above was followed between 1987 and 2010 in the National Patient Register and the Cause of Death Register. Annual age-specific hip fracture cumulative incidence was estimated using hospital admissions for hip fractures. Three-month and one-year survival after the first hip fracture were also estimated. Period life table was used to assess lifetime risk of hip fractures occurring from age 60 and above, and the expected mean age of the first hip fracture. RESULTS The age-specific hip fracture incidence decreased between 1995 and 2010 in all ages up to 94 years, on average by 1% per year. The lifetime risk remained almost stable, between 9% and 11% for men, and between 18% and 20% for women. The expected mean age of a first hip fracture increased by 2.5 years for men and by 2.2 years for women. No improvements over time were observed for the 3-month survival for men, while for women a 1% decrease per year was observed. The 1-year survival slightly increased over time for men (0.4% per year) while no improvement was observed for women. CONCLUSIONS The age-specific hip fracture incidence has decreased over time. Yet the lifetime risk of a hip fracture has not decreased because life expectancy in the population has increased in parallel. Overall, survival after hip fracture has not improved.
Collapse
Affiliation(s)
- Korinna Karampampa
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden.
| | - Anders Ahlbom
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Karl Michaëlsson
- Uppsala Clinical Research center (UCR) and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tomas Andersson
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Sven Drefahl
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden; Department of Sociology, Demography Unit, Stockholm University, Stockholm, Sweden
| | - Karin Modig
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
20
|
Rigattieri S, Sciahbasi A, Drefahl S, Mussino E, Cera M, Di Russo C, Fedele S, Pugliese FR. Transradial access and radiation exposure in diagnostic and interventional coronary procedures. J Invasive Cardiol 2014; 26:469-474. [PMID: 25198491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Although transradial access (TRA) is being increasingly used in interventional cardiology, there are concerns about a possible increase in radiation exposure (RE) as compared to transfemoral access (TFA). METHODS In this retrospective study, we aimed to compare RE during coronary angiography and percutaneous coronary intervention (PCI) according to the vascular access route (TRA vs TFA). We included all procedures performed in our laboratory, in which RE data (dose area product, cGy•cm²) were available, from May 2009 to May 2013. Both multiple linear regression analysis and propensity score matching were performed in order to compare RE between TRA and TFA after adjusting for clinical and procedural confounders. RESULTS DAP values were available for 1396 procedures; TRA rate was 82.6%. TRA patients were younger, less frequently female, and had higher body mass index as compared to TFA patients; the rates of PCI, ad hoc PCI, bypass angiography, thrombus aspiration, and primary angioplasty, as well as the number of stents implanted, fluoroscopy time, and contrast dose were significantly higher in TFA. Median DAP value was significantly higher in TFA than in TRA (9670 cGy•cm² vs 7635 cGy•cm²; P<.01). After adjusting for clinical and procedural confounders, vascular access was not found to be an independent predictor of RE at multiple regression analysis; this was also confirmed by stratified comparison of DAP values by quintiles of propensity score. CONCLUSION After adjusting for clinical and procedural confounders, TRA was not found to be associated with increased RE as compared to TFA in an experienced TRA center.
Collapse
Affiliation(s)
- Stefano Rigattieri
- UOSD Emodinamica Interventistica, Ospedale Sandro Pertini, Via dei Monti Tiburtini 385, 00157 Roma, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Karampampa K, Andersson T, Drefahl S, Ahlbom A, Modig K. Does improved survival lead to a more fragile population: time trends in second and third hospital admissions among men and women above the age of 60 in Sweden. PLoS One 2014; 9:e99034. [PMID: 24911650 PMCID: PMC4049743 DOI: 10.1371/journal.pone.0099034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background Life expectancy and time to first hospitalization have been prolonged, indicating that people live longer without needing hospital care. Life expectancy increased partially due to improved survival from severe diseases, which, however, could lead to a more fragile population. If so, time to a subsequent hospitalization could decrease. Alternatively, the overall trend of improved health could continue after the first hospitalization, prolonging also the time to subsequent hospitalizations. This study analyzes trends in subsequent hospitalizations among Swedish men and women above the age of 60, relating them to first hospitalization. It also looks at trends in the proportion of never hospitalized. Methods Individuals were followed in national registers for hospital admissions and deaths between 1972 and 2010. The proportion of never hospitalized individuals at given ages and time points, and the annual change in the risks of first and subsequent hospitalizations, were calculated. Findings An increase in the proportion of never hospitalized was seen over time. The risks of first as well as subsequent hospitalizations were reduced by almost 10% per decade for both men and women. Improvements were observed mainly for individuals below the ages of 90 and up to the year 2000. Conclusions The reduction in annual risk of both first and subsequent hospitalizations up to 90 years of age speaks in favor of a postponement of the overall morbidity among the elderly and provides no support for the hypothesis that the population becomes more fragile due to increased survival from severe diseases.
Collapse
Affiliation(s)
- Korinna Karampampa
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Tomas Andersson
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Sven Drefahl
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Department of Sociology, Demography Unit, Stockholm University, Stockholm, Sweden
| | - Anders Ahlbom
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
22
|
Donrovich R, Drefahl S, Koupil I. Early life conditions, partnership histories, and mortality risk for Swedish men and women born 1915-1929. Soc Sci Med 2014; 108:60-7. [PMID: 24608121 DOI: 10.1016/j.socscimed.2014.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 02/18/2014] [Accepted: 02/21/2014] [Indexed: 10/25/2022]
Abstract
This paper investigates the relationship between early life biological and social factors, partnership history, and mortality risk. Mortality risks for Swedish men and women over age 50 in the Uppsala Birth Cohort born 1915-1929 were estimated using survival analysis. Relative mortality risk was evaluated through nested multiplicative Gompertz models for 4348 men and 3331 women, followed from age 50 to the end of 2010. Being born to an unmarried mother was associated with higher mortality risk in later life for men and women, and relative to married individuals, being unmarried after age 50 was associated with elevated mortality risk. Single women and divorced men were the highest risk groups, and women were negatively impacted by a previous divorce or widowhood, while men were not. Both genders showed direct effects of early life variables on later life mortality and were vulnerable if unmarried in later life. However, in this study, previous marital disruptions appeared to have more (negative) meaning in the long-term for women.
Collapse
Affiliation(s)
- Robyn Donrovich
- Family and Population Studies (FaPOS), Centre for Sociological Research, KU Leuven, Parkstraat 45-Box 3601, 3000 Leuven, Belgium.
| | - Sven Drefahl
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Ilona Koupil
- Center for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
23
|
Abstract
BACKGROUND In the beginning of the 1970s, Sweden was the country where both women and men enjoyed the world's longest life expectancy. While life expectancy continues to be high and increasing, Sweden has been losing ground in relation to other leading countries. METHODS We look at life expectancy over the years 1970-2008 for men and women. To assess the relative contributions of age, causes of death, and smoking we decompose differences in life expectancy between Sweden and two leading countries, Japan and France. This study is the first to use this decomposition method to observe how smoking related deaths contribute to life expectancy differences between countries. RESULTS Sweden has maintained very low mortality at young and working ages for both men and women compared to France and Japan. However, mortality at ages above 65 has become considerably higher in Sweden than in the other leading countries because the decrease has been faster in those countries. Different trends for circulatory diseases were the largest contributor to this development in both sexes but for women also cancer played a role. Mortality from neoplasms has been considerably low for Swedish men. Smoking attributable mortality plays a modest role for women, whereas it is substantially lower in Swedish men than in French and Japanese men. CONCLUSIONS Sweden is losing ground in relation to other leading countries with respect to life expectancy because mortality at high ages improves more slowly than in the leading countries, especially due to trends in cardiovascular disease mortality. Trends in smoking rates may provide a partial explanation for the trends in women; however, it is not possible to isolate one single explanatory factor for why Sweden is losing ground.
Collapse
Affiliation(s)
- Sven Drefahl
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Anders Ahlbom
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
24
|
|
25
|
Karampampa K, Drefahl S, Andersson T, Ahlbom A, Modig K. Trends in age at first hospital admission in relation to trends in life expectancy in Swedish men and women above the age of 60. BMJ Open 2013; 3:e003447. [PMID: 24065698 PMCID: PMC3787478 DOI: 10.1136/bmjopen-2013-003447] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To examine whether the first admission to hospital after the age of 60 has been postponed to higher ages for men and women in Sweden, in line with the shift in mortality. DESIGN This nationwide observational study was based on data obtained from national registries in Sweden. The study cohort was created by linking the Register of the Total Population in Sweden with the National Patient Register and the Swedish Cause of Death Register. SETTING The entire Swedish population born between 1895 and 1950 was followed up between 1987 and 2010 with respect to hospital admissions and deaths using the national registry data. PRIMARY OUTCOME MEASURES The time from age 60 until the first admission to the hospital, regardless of the diagnosis, and the time from age 60 until death (remaining life expectancy, LE) were estimated for the years 1995-2010. The difference between these two measures was also estimated for the same period. RESULTS Between 1995 and 2010 mortality as well as first hospital admission shifted to higher ages. The average time from age 60, 70, 80 and 90 until the first hospital admission increased at all ages. The remaining LE at age 60, 70 and 80 increased for men and women. For the 90-year-olds it was stable. CONCLUSIONS In Sweden, the first hospital admission after the age of 60 has been pushed to higher ages in line with mortality for the ages 60 and above. First admission to the hospital could indicate the onset of first severe morbidity; however, the reorganisation of healthcare may also have influenced the observed trends.
Collapse
Affiliation(s)
- Korinna Karampampa
- Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Drefahl
- Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Sociology, Demography Unit, Stockholm University, Stockholm, Sweden
| | - Tomas Andersson
- Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Anders Ahlbom
- Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
26
|
Affiliation(s)
- Karin Modig
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden and Department of Sociology, Demography Unit, Stockholm University, Stockholm, Sweden
- *Corresponding author. Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden. E-mail:
| | - Sven Drefahl
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden and Department of Sociology, Demography Unit, Stockholm University, Stockholm, Sweden
| | - Anders Ahlbom
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden and Department of Sociology, Demography Unit, Stockholm University, Stockholm, Sweden
| |
Collapse
|
27
|
Ljung R, Drefahl S, Andersson G, Lagergren J. Socio-demographic and geographical factors in esophageal and gastric cancer mortality in Sweden. PLoS One 2013; 8:e62067. [PMID: 23637965 PMCID: PMC3630145 DOI: 10.1371/journal.pone.0062067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 03/17/2013] [Indexed: 01/29/2023] Open
Abstract
Background Socio-demographic factors and area of residence might influence the development of esophageal and gastric cancer. Large-scale population-based research can determine the role of such factors. Methods This population-based cohort study included all Swedish residents aged 30–84 years in 1990–2007. Educational level, marital status, place of birth, and place of residence were evaluated with regard to mortality from esophageal or gastric cancer. Cox regression yielded hazard ratios (HR) with 95% confidence intervals (CI), adjusted for potential confounding. Results Among 84 920 565 person-years, 5125 and 12 230 deaths occurred from esophageal cancer and gastric cancer, respectively. Higher educational level decreased the HR of esophageal cancer (HR = 0.61, 95%CI 0.42–0.90 in women, HR = 0.71, 95%CI 0.60–0.84 in men) and gastric cancer (HR = 0.80, 95%CI 0.63–1.03 in women, HR = 0.73, 95%CI 0.64–0.83 in men). Being unmarried increased HR of esophageal cancer (HR = 1.64, 95%CI 1.35–1.99 in women, HR = 1.64, 95%CI 1.50–1.80 in men), but not of gastric cancer. Being born in low density populated areas increased HR of gastric cancer (HR = 1.23, 95%CI 1.10–1.38 in women, HR = 1.37, 95%CI 1.25–1.50 in men), while no strong association was found with esophageal cancer. Living in densely populated areas increased HR of esophageal cancer (HR = 1.31, 95%CI 1.14–1.50 in women, HR = 1.40, 95%CI 1.29–1.51 in men), but not of gastric cancer. Conclusion These socio-demographic inequalities in cancer mortality warrant efforts to investigate possible preventable mechanisms and to promote and support healthier lifestyles among deprived groups.
Collapse
Affiliation(s)
- Rickard Ljung
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | |
Collapse
|
28
|
|
29
|
Modig K, Drefahl S, Andersson T, Ahlbom A. The aging population in Sweden: can declining incidence rates in MI, stroke and cancer counterbalance the future demographic challenges? Eur J Epidemiol 2012; 27:139-45. [PMID: 22350145 DOI: 10.1007/s10654-012-9653-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 01/16/2012] [Indexed: 10/28/2022]
Abstract
It is often taken for granted that an ageing population will lead to an increased burden for the health care sector. However, for several diseases of big public health impact the rates have actually come down for a substantial period of time. In this study we investigate how much the incidence rates for myocardial infarction (MI), stroke, and cancer will have to decline in order to counterbalance future demographic changes (changes in population size and age structure) and compare these figures with observed historical trends. Information on incidence rates were obtained from the National Board of Health and Welfare and referred to the total Swedish population. Population projections were obtained from Statistics Sweden. We projected the number of MI events to increase 50-60% between 2010 and 2050. The decline in incidence rates that is required to keep the number of events constant over time is, on average, 1.2%/year for men and 0.9%/year for women, somewhat higher than the trend for the past 10 years. For stroke the corresponding figures were 1.3% (men) and 1% (women), well in line with historical trends. For cancer the results indicate an increasing number of events in the future. Population ageing is more important than population growth when projecting future number of MI, stroke and cancer events. The required changes in incidence rates in order to counterbalance the demographic changes are well in line with historical figures for stroke, almost in line regarding MI, but not in line regarding cancer. For diseases with age dependence similar to these diseases, a reduction of incidence rates in the order of 1-2% is sufficient to offset the challenges of the ageing population. These are changes that have been observed for several diseases indicating that the challenges posed by the ageing population may not be as severe as they may seem when considering the demographic component alone.
Collapse
Affiliation(s)
- Karin Modig
- Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Box 210, 171 77 Stockholm, Sweden.
| | | | | | | |
Collapse
|
30
|
Ahlbom A, Drefahl S, Lundström H. [The aging population. Continuing increase of average longevity is a controversial and exciting question]. Lakartidningen 2010; 107:3048-3051. [PMID: 21287750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Anders Ahlbom
- Institutet för miljömedicin, Karolinska institutet, Stockholm.
| | | | | |
Collapse
|
31
|
Abstract
I use hazard regression methods to examine how the age difference between spouses affects their survival. In many countries, the age difference between spouses at marriage has remained relatively stable for several decades. In Denmark, men are, on average, about three years older than the women they marry. Previous studies of the age gap between spouses with respect to mortality found that having a younger spouse is beneficial, while having an older spouse is detrimental for one's own survival. Most of the observed effects could not be explained satisfactorily until now, mainly because of methodological drawbacks and insufficiency of the data. The most common explanations refer to selection effects, caregiving in later life, and some positive psychological and sociological effects of having a younger spouse. The present study extends earlier work by using longitudinal Danish register data that include the entire history of key demographic events of the whole population from 1990 onward. Controlling for confounding factors such as education and wealth, results suggest that having a younger spouse is beneficial for men but detrimental for women, while having an older spouse is detrimental for both sexes.
Collapse
Affiliation(s)
- Sven Drefahl
- Demography Unit, Department of Sociology, University of Stockholm, 10691 Stockholm, Sweden.
| |
Collapse
|
32
|
Drefahl S. Erratum to: How does the age gap between partners affect their survival? Demography 2010. [DOI: 10.1007/bf03213768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sven Drefahl
- Demography Unit, Department of Sociology, University of Stockholm, Stockholm 10691, Sweden
| |
Collapse
|